The use of Sirolimus should be restricted in liver transplantation

Sirolimus and mTOR inhibitors are important additions to the therapeutic armamentarium to prevent allograft rejection, but their role in liver transplantation is evolving. De novo use of Sirolimus in the early post-transplant period has undoubtedly been influenced by the high incidence of hepatic ar...

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Bibliographic Details
Published in:Journal of hepatology 2012-01, Vol.56 (1), p.288-290
Main Authors: Massoud, Omar, Wiesner, Russell H
Format: Article
Language:English
Subjects:
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Immunosuppressive Agents - adverse effects
Liver Transplantation
Liver, biliary tract, pancreas, portal circulation, spleen
Medical sciences
Pharmacology. Drug treatments
Sirolimus - adverse effects
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
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Summary:Sirolimus and mTOR inhibitors are important additions to the therapeutic armamentarium to prevent allograft rejection, but their role in liver transplantation is evolving. De novo use of Sirolimus in the early post-transplant period has undoubtedly been influenced by the high incidence of hepatic artery thrombosis and decreased patient and graft survival leading to a black box warning. The jury remains undecided on the role of conversion from CNIs to mTOR inhibitors in those developing renal insufficiency and it must be noted that a second warning was issued by the FDA because of decreased survival in those conversion studies. Finally, the anti-atherogenic, antiviral, and anti-neoplastic effects associated with Sirolimus, which might favor their use in certain liver transplant patients, need further evaluation before firm recommendations can be made.
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2011.06.012